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[Conditions](https://durgical.com/en/conditions/) · [Emergency medicine and toxicology](https://durgical.com/en/conditions/)

# Acute alcohol (ethanol) intoxication

Heavy drinking in a short time depresses the brain; at high levels it can stop breathing, cause choking on vomit and dangerously low body temperature.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/)
- [Frontal lobe](https://durgical.com/en/anatomy/superior-frontal-gyrus/)
- [Liver](https://durgical.com/en/anatomy/liver/)
- [Medulla oblongata](https://durgical.com/en/anatomy/medulla-oblongata/)
- [Hypothalamus](https://durgical.com/en/anatomy/hypothalamus/)
- [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/)
- [Stomach](https://durgical.com/en/anatomy/stomach/)
- [Pancreas](https://durgical.com/en/anatomy/pancreas/)

## Why it happens

- [Alcohol: how it injures the liver, brain, heart and fetus](https://durgical.com/en/general-pathology/alcohol-how-it-injures-the-liver-brain-heart-and-fetus/)
- [The main neurotransmitters](https://durgical.com/en/physiology/the-main-neurotransmitters/)
- [Functions of the cerebellum](https://durgical.com/en/physiology/functions-of-the-cerebellum/)
- [Ethanol metabolism](https://durgical.com/en/biochemistry/pathways/ethanol-metabolism/)
- [Ethanol](https://durgical.com/en/biochemistry/molecules/ethanol/)

## What it is

The reversible but potentially lethal effects of recent ethanol intake. It ranges from disinhibition and incoordination to coma, respiratory depression and death («alcohol poisoning» or alcohol overdose). Alcohol withdrawal and delirium tremens are separate entities.

## Who gets it

Ethanol is the most widely used psychoactive substance in Colombia and Latin America, and alcohol intoxication is a frequent reason for emergency visits, often linked with road crashes, violence, falls and injuries. Binge drinking in adolescents and young adults, and consumption of illegal or adulterated spirits (with methanol risk), are regional concerns.

## Causes

- Binge or high-intensity drinking of beer, wine, spirits or home-made liquor («chirrinchi», «guarapo», «biche»)
- Accidental ingestion in children (drinks, mouthwash, perfumes, hand sanitiser)
- Combination with other depressants (benzodiazepines, opioids)

## Risk factors

- Adolescence and young adulthood; drinking games and celebrations
- Low body weight, female sex, and drinking on an empty [stomach](https://durgical.com/en/anatomy/stomach/)
- Lack of tolerance (occasional drinkers, children)
- Concurrent use of sedatives or opioids
- Alcohol use disorder

## Pathophysiology

Ethanol enhances GABA-A receptor activity and inhibits NMDA glutamate receptors, depressing the central [nervous system](https://durgical.com/en/anatomy/system/nervous-system/) in a dose-related way: first the frontal cortex (disinhibition, judgement), then the [cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) (ataxia, nystagmus), and finally the brainstem (respiratory depression, coma). It is metabolised mainly in the [liver](https://durgical.com/en/anatomy/liver/) by alcohol dehydrogenase at a near-constant rate; the excess NADH inhibits gluconeogenesis, causing hypoglycaemia, especially in children and fasting people. Vasodilation favours heat loss and hypothermia, and diuresis results from inhibited antidiuretic hormone.

## Classification

- Mild: euphoria, disinhibition, mild incoordination
- Moderate: slurred speech, ataxia, nystagmus, emotional lability, vomiting
- Severe: stupor or coma, hypotension, hypothermia, respiratory depression

## Symptoms and signs

- Smell of alcohol, flushing, talkativeness and disinhibition
- Slurred speech, unsteady gait, nystagmus
- Nausea and vomiting
- Drowsiness, confusion or aggression
- Memory loss for the episode (blackout)

## Red flags

- Unresponsiveness or not waking to pain
- Slow, irregular or noisy breathing; vomiting while drowsy
- Low body temperature, cold clammy [skin](https://durgical.com/en/anatomy/skin/)
- Seizures, or low blood glucose
- Head injury, focal signs or a level of consciousness that does not improve as expected

## Diagnosis

**Clinical**
Based on history of intake and examination, but intoxication is a diagnosis of exclusion in a patient with altered consciousness: always check glucose and look for head injury, other drugs, infection, hypothermia and toxic alcohols. Reassess frequently; a patient who does not improve over hours needs further investigation.

**Tests**
Capillary glucose immediately; blood or breath ethanol level where available; electrolytes, renal function, blood gases and osmolar gap if methanol or ethylene glycol is suspected; toxicology screen when co-ingestion is likely.

**Imaging**
Head CT when there is trauma, focal neurological signs or unexplained or worsening coma.

## Differential diagnosis

- Hypoglycaemia
- Traumatic brain injury and subdural haematoma
- Methanol or ethylene glycol poisoning
- Benzodiazepine or opioid overdose
- Wernicke encephalopathy
- Hepatic encephalopathy, CNS infection or post-ictal state

## Goal of treatment

Protect the airway and breathing, correct glucose and temperature, and look for associated injuries or poisonings while the body clears the alcohol.

## Treatment

**Acute**
ABC approach: lateral recovery position, airway protection and intubation if coma or respiratory depression; oxygen as needed.

**Medical**
Treat hypoglycaemia with intravenous glucose; give thiamine before or with glucose in malnourished or chronic drinkers to prevent Wernicke encephalopathy.

**Conservative**
Intravenous fluids for hypotension or dehydration, antiemetics, warming for hypothermia. There is no antidote; activated charcoal and gastric lavage are not useful for ethanol alone.

**Follow-up**
Nursing priorities: frequent level of consciousness, airway and aspiration risk, respiratory rate, temperature and glucose; prevent falls and self-harm; never leave a sleeping intoxicated patient unobserved.

**Lifestyle**
Brief intervention before discharge and referral for alcohol use disorder when appropriate; safe discharge only with a responsible adult.

## Complications

- Aspiration of vomit and aspiration pneumonia
- Respiratory depression and death
- Hypoglycaemia and hypothermia
- Trauma, road crashes, violence and sexual assault
- Mallory–Weiss tear, acute pancreatitis, rhabdomyolysis
- Arrhythmias («holiday heart»)

## Prognosis

Most patients recover fully within hours with supportive care. Deaths result from respiratory depression, aspiration, hypothermia or associated trauma, and from co-ingested sedatives.

## Prevention

- Avoid binge drinking and mixing alcohol with sedatives or opioids
- Never leave an intoxicated person alone; place them on their side
- Buy alcohol only from legal sources to avoid methanol-adulterated liquor
- Keep alcohol-containing products away from children

## Test yourself

Think of the answer, then tap the question to see it.

## Which glucose abnormality is typical of alcohol intoxication in children and fasting adults?

Hypoglycaemia, because ethanol metabolism raises NADH and inhibits gluconeogenesis.

## Why should thiamine be given with glucose to a malnourished drinker?

Glucose loading can precipitate Wernicke encephalopathy in thiamine-deficient patients.

## Which brain area explains the ataxia and nystagmus of intoxication?

The cerebellum, which is affected after the frontal cortex and before the brainstem as levels rise.

## What should be suspected if an intoxicated patient's coma does not improve over several hours?

Another cause: head injury, hypoglycaemia, co-ingested drugs, toxic alcohols or CNS infection; imaging and further tests are needed.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/acute-alcohol-intoxication/)

## Related conditions

- [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/)
- [Alcohol withdrawal and delirium tremens](https://durgical.com/en/conditions/alcohol-withdrawal-and-delirium-tremens/)
- [Wernicke encephalopathy (thiamine deficiency)](https://durgical.com/en/conditions/wernicke-encephalopathy/)
- [Hypoglycaemia (including insulin-induced)](https://durgical.com/en/conditions/hypoglycaemia/)
- [Aspiration pneumonia and pneumonitis](https://durgical.com/en/conditions/aspiration-pneumonia-and-pneumonitis/)
- [Accidental hypothermia](https://durgical.com/en/conditions/accidental-hypothermia/)
- [Traumatic brain injury](https://durgical.com/en/conditions/traumatic-brain-injury/)
- [Subdural haematoma](https://durgical.com/en/conditions/subdural-haematoma/)
- [Methanol poisoning](https://durgical.com/en/conditions/methanol-poisoning/)
- [Ethylene glycol poisoning](https://durgical.com/en/conditions/ethylene-glycol-poisoning/)
- [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/)
- [Mallory-Weiss syndrome](https://durgical.com/en/conditions/mallory-weiss-syndrome/)
- [Benzodiazepine overdose](https://durgical.com/en/conditions/benzodiazepine-overdose/)
- [Opioid overdose](https://durgical.com/en/conditions/opioid-overdose/)
- [Rhabdomyolysis](https://durgical.com/en/conditions/rhabdomyolysis/)
- [Alcoholic liver disease (biochemistry)](https://durgical.com/en/conditions/alcoholic-liver-disease/)
- [Disulfiram–ethanol reaction](https://durgical.com/en/conditions/disulfiram-ethanol-reaction/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Understanding the Dangers of Alcohol Overdose](https://www.niaaa.nih.gov/alcohol-poisoning) (National Institute on Alcohol Abuse and Alcoholism (NIAAA), 2026); Guía para el manejo de emergencias toxicológicas (Ministerio de Salud y Protección Social (Colombia) / OPS, 2017).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/acute-alcohol-intoxication/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/acute-alcohol-intoxication/